BACKGROUND: It is very difficult to find a consensus that will be accepted by most players when creating health care legislation. The Czech electronic prescription system was launched in 2011 and new functions were introduced in 2018. To ensure that these functions will not conflict with any other existing law, a process modeling tool based on the patent "Method and system for automated requirements modeling" was used successfully in the Czech Republic for the first time. OBJECTIVE: The aim of this project was to develop another successful application of process modeling to add COVID-19 vaccination records to the existing electronic prescription system. METHODS: The method employed was based on the mathematical theory of hierarchical state diagrams and process models. In the first step, sketches that record the results of informal discussions, interviews, meetings, and workshops were prepared. Subsequently, the architecture containing the main participants and their high-level interactions was drafted. Finally, detailed process diagrams were drawn. Each semiresult was discussed with all involved team members and stakeholders to incorporate all comments. By repeating this procedure, individual topics were gradually resolved and the areas of discussion were narrowed down until reaching complete agreement. RESULTS: This method proved to be faster, clearer, and significantly simpler than other methods. Owing to the use of graphic tools and symbols, the risk of errors, inaccuracies, and misunderstandings was significantly reduced. The outcome was used as an annex to the bill in the legislative process. One of the main benefits of this approach is gaining a higher level of understanding for all parties involved (ie, legislators, the medical community, patient organizations, and information technology professionals). The process architecture model in a form of a graphic scheme has proven to be a valuable communication platform and facilitated negotiation between stakeholders. Moreover, this model helped to avoid several inconsistencies that appeared during workshops and discussions. Our method worked successfully even when participants were from different knowledge areas. CONCLUSIONS: The vaccination record process model was drafted in 3 weeks and it took a total of 2 months to pass the bill. In comparison, the initial introduction of the electronic prescription system using conventional legislative methods took over 1 year, involving immediate creation of a text with legislative intent, followed by paragraph-by-section wording of the legislation that was commented on directly. These steps are repeated over and over, as any change in any part of the text has to be checked and rechecked within the entire document. Compared with conventional methods, we have shown that using our method for the process of modification of legislation related to such a complex issue as the integration of COVID-19 vaccination into an electronic prescription model significantly simplifies the preparation of a legislative standard.

Department of Anesthesiology and Intensive Care General Teaching Hospital Praha Czech Republic

Department of Biomedical Technology Faculty of Biomedical Engineering Czech Technical University Prague Kladno Czech Republic

Institute of Pathological Physiology 1st Faculty of Medicine Charles University Prague Praha Czech Republic

Zobrazit více v PubMed

Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med. 2011 Jan 18;8(1):e1000387. doi: 10.1371/journal.pmed.1000387. PubMed DOI PMC

Bruthans J. The past and current state of the Czech outpatient electronic prescription (eRecept) Int J Med Inform. 2019 Mar;123:49–53. doi: 10.1016/j.ijmedinf.2019.01.003.S1386-5056(18)31170-5 PubMed DOI

Bruthans J. The state of national electronic prescription systems in the EU in 2018 with special consideration given to interoperability issues. Int J Med Inform. 2020 Sep;141:104205. doi: 10.1016/j.ijmedinf.2020.104205.S1386-5056(20)30236-7 PubMed DOI

Berger J. Method and System for Automated Request Modelling. US Patent 7,904,431 B1. Google Patents. 2011. [2023-02-20]. https://patentimages.storage.googleapis.com/4f/3b/91/efd8c98d224638/US7904431.pdf .

Iglesias N, Juarez J, Campos M. Business process model and notation and openEHR task planning for clinical pathway standards in infections: critical analysis. J Med Internet Res. 2022 Sep 15;24(9):e29927. doi: 10.2196/29927. v24i9e29927 PubMed DOI PMC

Percival J, McGregor C. An evaluation of understandability of patient journey models in mental health. JMIR Hum Factors. 2016 Jul 28;3(2):e20. doi: 10.2196/humanfactors.5640. v3i2e20 PubMed DOI PMC

Craft.CASE Business Process Analysis. [2023-02-21]. https://craftcase.com/

Knott R, Merunka V, Polak J. The BORM methodology: a third-generation fully object-oriented methodology. Knowl Based Syst. 2003 Mar;16(2):77–89. doi: 10.1016/S0950-7051(02)00075-8. DOI

Knott RP, Merunka V, Polak J. Process modeling for object oriented analysis using BORM Object Behavioral Analysis. Fourth International Conference on Requirements Engineering (ICRE 2000); June 19-23, 2000; Schaumburg, IL. 2000. DOI

Leo CG, Mincarone P, Bodini A, Sedile R, Guarino R, Tumolo M, Malorgio R, Quitadamo M, Sabato E, Viegi G, Insalaco G, Sabina S. Obstructive sleep apnoea: Improving healthcare services by combining process modelling and population analysis. Int J Med Inform. 2019 Jul;127:43–51. doi: 10.1016/j.ijmedinf.2019.04.013.S1386-5056(18)31426-6 PubMed DOI

Cornet R, Randell R, McCowan C, Peek N, Scott PJ. Informatics for health: connected citizen-led wellness and population health. Washington, DC: IOS Press; 2017.

Essefi I, Rahmouni HB, Ladeb MF. Sensitive data discovery in care pathways using business process modelling and HL7-CDA. Int J Adv Life Sci. 2019;11(2):56–67.

Terras Marques I, Santos C, Santos V. Process modelling of organized screening programs – breast cancer. Eur J Public Health. 2020;30:ckaa166. doi: 10.1093/eurpub/ckaa166.022. DOI

Buics L, Eisinger BB. Analyzing public service processes from customer and employee perspectives by using service blueprinting and business process modelling. ENTRENOVA - ENTerprise REsearch InNOVAtion Conference (2020); September 10-12, 2020; virtual. 2020.

Bartolini C, Calabró A, Marchetti E. Enhancing business process modelling with data protection compliance: an ontology-based Proposal. 5th International Conference on Information Systems Security and Privacy (ICISSP 2019); February 23-25, 2019; Prague, Czech Republic. 2019. DOI

Ly S, Runacres F, Poon P. Journey mapping as a novel approach to healthcare: a qualitative mixed methods study in palliative care. BMC Health Serv Res. 2021 Sep 04;21(1):915. doi: 10.1186/s12913-021-06934-y. 10.1186/s12913-021-06934-y PubMed DOI PMC

Joffe M, Mindell J. Complex causal process diagrams for analyzing the health impacts of policy interventions. Am J Public Health. 2006 Mar;96(3):473–479. doi: 10.2105/AJPH.2005.063693.AJPH.2005.063693 PubMed DOI PMC

Archer N, Lokker C, Ghasemaghaei M, DiLiberto D. eHealth implementation issues in low-resource countries: model, survey, and analysis of user experience. J Med Internet Res. 2021 Jun 18;23(6):e23715. doi: 10.2196/23715. v23i6e23715 PubMed DOI PMC

Tossaint-Schoenmakers R, Versluis A, Chavannes N, Talboom-Kamp E, Kasteleyn M. The challenge of integrating eHealth into health care: systematic literature review of the Donabedian model of structure, process, and outcome. J Med Internet Res. 2021 May 10;23(5):e27180. doi: 10.2196/27180. v23i5e27180 PubMed DOI PMC

Berger J Main process modules of ePrescription (original data for Figure 2A) efractal. [2023-02-21]. https://www.e-fractal.cz/media/ep_article/figure2_detail.png .

Berger J Main process modules of ePrescription with added vaccination record (original data for Figure 2B) efractal. [2023-02-21]. https://www.e-fractal.cz/media/ep_article/figure3_detail.png .